The responsiveness problem in psychotherapy: A review of proposed solutions.

Background: Therapist responsiveness is defined as therapist behavior being influenced by emerging context.Responsiveness is ubiquitous and creates serious problems for a ballistic, cause-effect understanding of how psychotherapy works.This conceptual literature review examines ways psychotherapy researchers have constructively engaged the responsiveness problem.Method: We noted classical approaches to the responsiveness problem, and, we reviewed all available citations of the formulation of the problem by Stiles, Honos-Webb and Surko (1998), focusing on proposed solutions.We identified N = 58 studies that cited the 1998 paper and engaged with the responsiveness problem.These, along with additional engagements with the responsiveness problem identified by us and by colleagues were reviewed.Results: We distinguished six categories of ways researchers have addressed the responsiveness problem: (a) demonstrating effects of responsiveness, (b) measuring responsiveness quantitatively, (c) describing responsiveness qualitatively, (d) using evaluative measures, (e) developing responsive clinical interventions, and (f) extending responsiveness concepts to related domains.Conclusions: There are ways to engage the responsiveness problem that are scientifically productive.However, appropriately engaging the problem may require some psychotherapy researchers to ask different questions than they have previously asked.